Echocardiographic assessment of right ventricular dysfunction and outcome in patients with severe Covid-19 Pneumonia

Figures & data

Table 1. Comparison between survivors and non-survivors of ARDS regarding baseline characteristics and right ventricular function parameters.

Characteristics	Survivors (n = 57)	Non-survivors (n = 33)	P value
Age[years] (mean ± SD)	46.60 ± 14.57	45.27 ± 13.66	0.672
Sex [n%]
Male	34(59.6)	13(39.4)	0.064
Female	23(40.4)	20(60.6)
Diabetes mellitus [n%]	8 (14.0)	10 (30.3)	0.063
Hypertension [n%]	9 (15.8)	8 (24.2)	0.324
Heart rate (beat/min) (mean ± SD)
Day1	95.12 ± 13.14	103.6 ± 19.36	0.031*
Day3	89.11 ± 8.73	95.64 ± 12.53	0.011*
Temperature (^oC) (mean ± SD)
Day1	38.54 ± 0.81	39.30 ± 0.88	<0.001*
Day3	38.04 ± 0.59	38.49 ± 0.71	0.002*
Respiratory rate (breath/min) (mean ± SD)
Day1	20.95 ± 2.86	22.48 ± 2.84	0.016*
Day3	19.23 ± 2.64	20.76 ± 4.07	0.002*
Mean arterial blood pressure (mmHg) (mean ± SD)
Day1	82.79 ± 9.93	74.09 ± 9.82	<0.001*
Day3	84.30 ± 7.86	66.91 ± 13.40	<0.001*
Vasopressor (Norepinephrine)
Need for it [n%]	6 (10.5)	16 (48.5)	<0.001*
Day of beginning (mean ± SD)	2.50 ± 0.84	3.06 ± 1.12	0.207
Duration [days] (mean ± SD)	3.0 ± 0.89	5.25 ± 1.98	0.020*
Inotropes
Need for it [n%]	2 (3.5)	8 (24.2)	0.004*
Day of beginning (mean ± SD)	3.50 ± 0.71	3.25 ± 0.71	0.665
Duration [days] (mean ± SD)	3.50 ± 0.71	4.50 ± 1.85	0.425
D. Dimer (mg/l) (mean ± SD)
Day1	0.89 ± 0.14	1.10 ± 0.19	<0.001*
Day3	0.54 ± 0.12	0.92 ± 0.27	<0.001*
Interleukin-6 (pg/ml) (mean ± SD)
Day1	77.16 ± 80.4	154.55 ± 249.65	0.002*
Day3	42.37 ± 35.81	70.79 ± 83.42	<0.001*
CRP (mg/l) (mean ± SD)
Day1	65.74 ± 66.33	79.0 ± 78.37	0.008*
Day3	34.84 ± 37.66	69.03 ± 55.48	<0.001*
PH (mean ± SD)	7.40 ± 0.05	7.38 ± 0.06	0.041*
PCO2 (mmHg) (mean ± SD)	36.25 ± 6.21	38.61 ± 6.40	0.089
PaO2/FiO2 (mean ± SD)	141.02 ± 35.37	122.88 ± 42.80	0.006*
HCO3 (mEq/L) (mean ± SD)	23.09 ± 2.15	23.09 ± 2.15	0.046*
RVFAC (%) (mean ± SD)
Day1	45.95 ± 13.23	34.33 ± 9.12	<0.001*
Day3	47.12 ± 11.55	47.12 ± 11.55	<0.001*
SPAP (mm Hg) (mean ± SD)
Day1	36.81 ± 12.22	56.27 ± 5.84	<0.001*
Day3	35.07 ± 10.63	56.85 ± 5.93	<0.001*
RV diameter (mm) (mean ± SD)
Day1	35.07 ± 5.07	40.09 ± 5.38	<0.001*
Day3	33.33 ± 4.54	41.48 ± 4.74	<0.001*
RV wall thickness (mm) (mean ± SD)
Day1	2.99 ± 0.71	2.49 ± 0.50	<0.001*
Day3	3.50 ± 0.88	2.42 ± 0.57	<0.001*
TAPSE (mm) (mean ± SD)
Day1	19.54 ± 3.75	13.73 ± 3.08	<0.001*
Day3	20.39 ± 3.44	11.88 ± 2.76	<0.001*
Invasive mechanical ventilation
Yes [n%]	7 (12.3)	33 (100)
No [n%]	50 (87.7)	0 (0.0)	<0.001*
Duration (days) (mean ± SD)	7.29 ± 1.80	5.76 ± 1.58	0.035*
Length of ICU stay(days) (mean ± SD)	12.91 ± 3.26	7.64 ± 3.06

Note: CRP:C reactive protein, HCO₃: serum bicarbonate, ICU: intensive care unit, PCO₂: partial pressure of carbon dioxide, PaO₂/FiO₂: partial pressure oxygen, RVFACL: Right ventricular fractional area change, RV: Right ventricle, SPAP: Systolic Pulmonary Artery Pressure, TAPSE: Tricuspid annular plane systolic excursion, *: Statistically significant at p≤ 0.05.

Table 2. Correlation between RV parameters with different parameters in total sample (n = 90).

RV parameters		PaO2/FiO2		Mechanical ventilation days		Average MAP
		rs	p	rs	p	r	p
RVFAC	day 1	0.248*	0.018*	−0.003	0.983	0.240*	0.023*
	day 3	0.263*	0.012*	−0.025	0.881	0.287*	0.006*
SPAP	day 1	−0.277*	0.008*	−0.221	0.171	−0.458*	<0.001*
	day 3	−0.268*	0.011*	−0.223	0.167	−0.497*	<0.001*
RV. D	day 1	−0.342*	0.001*	0.086	0.600	−0.278*	0.008*
	day 3	−0.275*	0.009*	−0.016	0.921	−0.420*	<0.001*
RV. WT	day 1	0.204	0.054	−0.039	0.810	0.204	0.053
	day 3	0.273*	0.009*	0.033	0.840	0.393*	<0.001*
TAPSE	day 1	0.249*	0.018*	−0.008	0.960	0.409*	<0.001*
	day 3	0.210*	0.047*	0.180	0.267	0.468*	<0.001*

RV: right ventricle, RVFAC: Right ventricular fractional area change, RV. D: Right ventricular diameter, RV. WT: Right ventricular wall thickness, SPAP: Systolic Pulmonary Artery Pressure, TAPSE: Tricuspid annular plane systolic excursion r: Pearson coefficient, rs: Spearman coefficient, *: Statistically significant at p ≤ 0.05.

Table 3. (A) Univariate and multivariate analyses for the parameters affecting mortality on day 1. (b) Univariate and multivariate analyses for the parameters affecting mortality on day 3.

Day 1	Univariate		Adjusted multivariate
	p	OR (95%C. I)	p	AOR# (95%C. I)
RVFAC	<0.001*	0.909* (0.863–0.957)	0.001*	0.886*(0.823–0.953)
SPAP	<0.001*	1.192*(1.106–1.284)	<0.001*	1.233*(1.105–1.376)
RV. D	<0.001*	1.184*(1.084–1.293)	0.001*	1.222*(1.087–1.375)
RV. WT	0.001*	0.253*(0.110–0.582)	0.008*	0.217*(0.071–0.667)
TAPSE	<0.001*	0.606*(0.491–0.749)	<0.001*	0.602*(0.467–0.775)
Day 3	Univariate		Adjusted multivariate
	p	OR (95%C.I)	p	AOR# (95%C.I)
RVFAC	<0.001*	0.839* (0.778–0.904)	<0.001*	0.837*(0.758–0.924)
SPAP	<0.001*	1.284*(1.147–1.438)	0.008*	1.559*(1.121–2.169)
RV. D	<0.001*	1.368 (1.211–1.545)	0.633	0.919 (0.649–1.300)
RV. WT	0.001*	0.137* (0.058–0.324)	0.167	8.089 (0.416–157.251)
TAPSE	<0.001*	0.483*(0.357–0.653)	0.142	0.612 (0.318–1.178)

RV: right ventricle, RVFAC: Right ventricular fractional area change, RV. D: Right ventricular diameter, RV. WT: Right ventricular wall thickness, SPAP: Systolic Pulmonary Artery Pressure, TAPSE: Tricuspid annular plane systolic excursion #: Adjusted OR with PaO₂/FiO₂, MAP, IL6, Need for vasopressors, and D. dimer admission, OR: Odd`s ratio, C.I: Confidence interval, *: Statistically significant at p ≤ 0.05.

Figure 1. ROC curve for different parameters to predict mortality in 1st day.

Figure 2. ROC curve for different parameters to predict mortality in 3rd day.

Table 4. (A) validity (AUC, sensitivity, specificity) for different parameters to predict mortality in 1st day. (b) validity (AUC, sensitivity, specificity) for different parameters to predict mortality in 3rd day.

1st day	AUC	p	95% C. I	Cut off#	Sensitivity	Specificity	PPV	NPV
RVFAC	0.762	<0.001*	0.663–0.860	≤38	72.73	64.91	54.5	80.4
SPAP	0.890	<0.001*	0.822–0.957	>46	93.94	77.19	70.5	95.7
RV. D	0.784	<0.001*	0.688–0.879	>34#	81.82	68.42	60.0	86.7
RV. WT	0.692	0.002*	0.582–0.803	≤2.3#	51.52	78.95	58.6	73.8
TAPSE	0.890	<0.001*	0.817–0.964	≤15	81.82	82.46	73.0	88.7
3rd day	AUC	p	95% C.I	Cut off#	Sensitivity	Specificity	PPV	NPV
RVFAC	0.907	<0.001*	0.836–0.979	≤33	87.88	84.21	76.3	92.3
SPAP	0.949	<0.001*	0.908–0.990	>44	96.97	77.19	71.1	97.8
RV. D	0.883	<0.001*	0.812–0.954	>38	81.82	84.21	75.0	88.9
RV. WT	0.845	<0.001*	0.762–0.929	≤2.9#	78.79	87.72	78.8	87.7
TAPSE	0.962	<0.001*	0.921–1.003	≤13	87.88	100.0	100.0	93.4

AUC: Area Under a Curve value, CI: Confidence Intervals, NPV: Negative predictive value, PPV: Positive predictive value RV: right ventricle, RVFAC :Right ventricular fractional area change, RV.D: Right ventricular diameter RV.WT: Right ventricular wall thickness, SPAP: Systolic Pulmonary Artery Pressure, p value: Probability, TAPSE: Tricuspid annular plane systolic excursion, *: Statistically significant at p ≤ 0.05, #Cut off was choose according to Youden index.